Behavioral risk factors and biomarkers of cardiovascular health in transgender and nonbinary individuals

Abstract

Background/Synopsis

Research exploring the cardiovascular health (CVH) of transgender and nonbinary individuals remains limited, and there is evidence that gender affirming hormone therapy (GAHT) may impact CVH. Moreover, the Gender Minority Stress and Resilience Model highlights the mental and physical health consequences of unique stressors that affect these individuals. Together, these factors place an ever-increasing importance on the role of CVH risk assessment within this population.

Objective/Purpose

To characterize behavioral risk factors and biomarkers of CVH among transgender and nonbinary individuals and to assess the role of mental health in modulating these risk factors.

Methods

Individuals ages 18 or older who identify as transgender male/female (TGM/TGF) or nonbinary (NB) were recruited. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were used to assess symptoms of depression and anxiety. Self-reported intake of specific food groups was converted to a score of 0-16, with higher diet scores reflecting larger quantities of potato chips, butter, fast-food, and soda and fewer quantities of fruits, vegetables, and beans. Weekly exercise was assessed using the International Physical Activity Questionnaire and converted to Metabolic Equivalent Tasks (METs). Diet scores, weekly METs, Body Mass Index (BMI), hemoglobin A1c (HbA1c), total cholesterol (TC), and low-density lipoprotein (LDL) levels were compared between those who screened positive on both the PHQ-2 and GAD-2 and those who screened negative. Unadjusted Mann-Whitney and Chi-square tests were performed; a p-value of under 0.05 was considered statistically significant.

Results

Seventy-eight participants were included: 24 TGM, 42 TGF, and 12 NB. Ages ranged from 18-69. 77% (n=60) of participants were on GAHT. Twenty-eight participants screened positive on both the PHQ-2 and GAD-2, and 34 participants screened negative for both. Participants who screened positive had less healthy diets than those who screened negative (average diet score 7.3 vs 6.0; p=0.0456). These participants also tended to be less likely to surpass the American Heart Association's recommended 600 weekly METs (57% of participants (n=16) vs 79% of participants (n=29); p=0.0584) and less likely to attain recommended levels of CVH biomarkers (Figure 1).

Conclusions

Our data highlight an important trend in which participants with symptoms of anxiety and depression had less healthy diets and were less likely to meet exercise and biomarker goals. With less than 50% of either group attaining target BMI or LDL levels, our data also underscore the significant overall CVH risk in this population.